卵巢透明细胞癌合并卵巢子宫内膜异位症的临床病理学分析

Clinicopathological features of ovarian clear cell carcinoma associated with ovarian endometriosis

目的探讨卵巢透明细胞癌(OCCC)合并卵巢子宫内膜异位症(EM)的临床表现、病理学特点及预后。方法选择2002年1月至2011年11月在大连市妇产医院行手术治疗并经术后病理学检查确诊为卵巢癌的444例患者中的60例OCCC患者为研究对象,按照是否合并卵巢EM,将其分为A组(n=7,OCCC合并卵巢EM恶变患者),B组(n=15,除A组患者以外的OCCC合并卵巢EM患者)和C组(n=38,OCCC未合并卵巢EM患者)。本研究遵循的程序符合大连市妇幼保健院人体试验委员会所制定的伦理学标准,得到该委员会批准,分组征得受试对象本人的知情同意,并与之签署临床研究知情同意书。通过查阅病历,记录研究对象的一般情况、临床症状、辅助检查结果、病理学特点及预后情况。结果 OCCC合并卵巢EM发生率为36.4%(22/60),OCCC合并卵巢EM恶变发生率为11.7%(7/60)。A组无生育史患者数多于C组,并且差异有统计学意义(χ2=23.72,P=0.021)。A组患者年龄显著低于C组,并且差异有统计学意义(F=24.48,P=0.005)。C组患者囊实混合性包块所占比例(81.6%)显著高于A组和B组(42.9%和53.3%),3组比较,差异有统计学意义(χ2=6.88,P=0.032)。A组(100.0%)和B组(93.3%)血清CA125水平<500U/L发生率均高于C组(84.2%),但3组比较,差异无统计学意义(P>0.05)。A组和B组患者患者Ⅰ期发生率显著高于C组(100%和80.0%vs 57.9%),3组比较,差异有统计学意义(χ2=6.10,P=0.047)。3组患者5年生存率比较,差异无统计学意义(P>0.05)。结论 OCCC合并卵巢EM患者常较年轻且无生育史,病理学分期以Ⅰ期为主,CA125水平相对较低,预后相对较好。年轻卵巢EM患者应警惕恶变可能。

Objective To explore the clinicopathological features and prognosis of patients with ovarian clear ceil careinoma（OCCC） associated with endometriosis（EM）. Methods From January 2002 to November 2011 ,a total of 60 women with OCCC were included in the study and analyzed retrospectively. They were divided into group A （n= 7,0CCC associated with malignant transformation ovarian EM） ,group B （n= 15, OCCC associated ovarian EM）and group C （n=38, OCCC only）. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Dalian Maternity Hospital. Informed consent was obtained from each participants. The clinical data were compared among these groups. Results The incidence rate of OCCC associated with ovarian EM was 36.4% （22/60）, and 11. 7% （7/60） women were diagnosed as OCCC associated with malignant transformation ovarian EM. There were more nulliparity in group A than that of group C, and significant difference was found between them（X^2=23. 72, P= 0. 021）. The mean age in group A was significantly younger than that of group C, and there was statistically significant difference （F = 24. 48, P = 0. 005 ）. Through ultrasound examination, Group C showed more cystic and solid mixed mass than that of other groups （81.6%s 42.9%and 53.3%）, and lhere were significant differences among them （X^2 = 6.88, P= 0. 032）. There was no significant difference among three groups in the incidence rate of serum CA125〈500 U/L（P〉0.05）. Most of the patients ingroups A and B were diagnosed at stage I , which was obviously higher than that of group C （100.0% and 80.0% vs 57.9%）, and there was statistically significant difference （X^2 =6. 10,P=0. 047）. The five-year survival rate among three groups were 50. 0%, 71. 4%, 36.8%, respectively, no significant difference was observed among them（P〉0.05）. Conclusions Most of OCCC associated ovarian EM patients were found to be younger, nonporous, and at an early stage, lower serum CA125 level with better prognosis. Young patients with ovarian EM still need to wary of the malignant transformation.